AB1154 HUMORAL AND CELLULAR RESPONSE TO A THIRD BOOSTER DOSE SARS-CoV- 2 VACCINATION IN PATIENTS WITH AUTOIMMUNE DISEASE: A CASE SERIES
Authors: T. Dimitroulas, A. Tychala, K. Defteraiou, E. Katsimpourlia, E. Sidiropoulou, M. Papachristou, A. Fylaktou, L. Skoura
Journal: Annals of the Rheumatic Diseases (2022)

Background Patients with systemic rheumatic diseases (SRD) are at increased risk for viral infections and successful vaccination is crucial to combat COVID-19 pandemic in this population. However, reduced antibody responses have been described in a proportion of SRD individuals on immunosuppressant agents including mycophenolate (MMF). Objectives We aimed to assess humoral and cellular response of SRD patients who received a booster SARS-CoV- 2 vaccination. Methods Twenty patients without history of COVID-19 infection (11 men, median age 58 years (range:38-74), 12 on treatment with MMF (2gr daily) due to systemic sclerosis (n= 6), inflammatory myositis (n=4) and systemic lupus erythematosus (n=2) and 8 on tumor necrosis factor-alpha inhibitors (anti-TNF) due to spondyloarthritis (n=5), rheumatoid arthritis (n=2) and Bechet disease (n=1) were included. All were on monotherapy with anti-TNF except patient with Bechet. Patients on MMF discontinued treatment for 1 week after the booster dose whistle no treatment modification was implemented in anti-TNF group. Serological response to vaccination was assessed using the Abbott SARS-CoV-2 IgG II Quant assay. Cellular immunity was estimated via interferon-γ produced by CD4+ and CD8+ T-lymphocytes in response to a SARS-CoV-2 peptide cocktail, with the SARS-CoV-2 ELISA Kit. Results Nineteen patients (95%) demonstrated positive serological response following booster vaccine dose (Table 1). Only one female patient in MMF group failed to develop adequate levels of antibodies. The median antibody titers of patients under MMF and anti-TNF was 647.90 BAU/mL (range: 0.71-4795.32 BAU/mL) and 542.98 BAU/mL (range: 4.32-1391.33 BAU/mL) respectively. No statistically significant difference was found between the two groups. Regarding cellular immunity a T-cell response was present in all patients on monotherapy with anti-TNF but only in 7/12 under MMF including the one with negative humoral response. Conclusion We report sufficient immunogenicity following a third booster vaccine in patients with RSD on immunossupresive medications coupled by a strong cellular immune response particularly in patients on anti-TNF monotherapy. Perrivaccination management of immunosuppressive therapy represents an important parameter of vaccine administration in patients with RSD. References [1]Connolly CM, Teles M, Frey S, et al. Booster-dose SARS-CoV-2 vaccination in patients with autoimmune disease: a case series. Ann Rheum Dis 2022;81:291-293. [2]Teles M, Connolly CM, Frey S, Chiang TP, Alejo JJ, Boyarsky BJ, Shah AA, Albayda J, Christopher-Stine L, Werbel WA, Segev DL, Paik JJ. Attenuatedresponse to fourth dose SARS-CoV-2 vaccination in patients with autoimmunedisease: a case series. Ann Rheum Dis 2022 publishes on Jan 17. doi:10.1136/annrheumdis-2021-221641 Epub ahead of print [3]Connolly CM, Chiang TP, Boyarsky BJ, et al. Temporary hold of mycophenolate augments humoral response to SARS-CoV-2 vaccination in patients with rheumatic and musculoskeletal diseases: a case series. Ann Rheum Dis 2022;81:293-295. Disclosure of Interests None declared